As I walked into the emergency department of our hospital, the stench hit me almost immediately. To say that the smell was very strong would have been a gross understatement. I looked around and found its source: a very ill-looking, aged, bed-ridden patient. There was one attendant with her and he had one of his hands to his face, with a piece of cloth covering his nose. There were other patients and relatives around, who were trying to move away. A couple of nurses among the staff had their noses covered.
Encountering things unpleasant to the senses is not unusual for healthcare workers. While it is hardly ever that odours linked to patients and hospitals are pleasant, it is well-recognised that odours may actually be helpful for medical practitioners. Characteristic odours are reported to be associated with many disease states, with the possibility that an astute physician with a keen sense of smell may be alerted to the possibility of a particular disease condition in a patient. Skin conditions, complications of diabetes, liver and kidney failure are all described to be associated with distinct odours. The only clue towards some rare metabolic diseases may be a peculiar odour emanating from the patient. Physicians may be deprived of this ability to exercise their olfactory sense to make a clinical diagnosis with the current practice of rampant use of body sprays by the public. In fact, as medical students, not only were we pulled up for using body sprays but we were also taught by our teachers that doctors should not use body sprays while at work.
But as health care workers, how are we supposed to deal with particularly unpleasant odours at work? There are some specialists who need to put up with unpleasant odours as part of routine work. Doctors who treat skin conditions, surgeons who deal with necrotic body parts requiring surgery, and the plastic surgeons treating patients with extensive burns, are some examples. As a medical student many years ago, I used to wonder how they coped with it. One of my forensic medicine professors taught me how, one day.
As medical students, we were expected to witness a minimum of 10 actual post-mortem examinations in the mortuary and submit a record of the details of those procedures. This required us to visit the part of the medical college hospital most infrequently visited by students — the mortuary. This was not a particularly pleasant experience, so we tended to do it in groups. One day or morning clinics got over early and two of us thought it better go and find out whether there were any autopsies being performed.
At the mortuary we were told the staff was about to start a post-mortem examination, and without a second thought we went inside. Only after entering the autopsy room did it hit us; it was the most putrid odour I had ever encountered in my life until then. They were doing an autopsy on the body of an unknown person found floating in a river. He must have been dead for at least a couple of days and was already in a state of decay.
I immediately pulled out my handkerchief and covered my nose, and both of us were about to make a dash to the exit, when the professor walked in. He signalled us to stay and proceeded to start with the autopsy. He watched both of us for a few of minutes and then stopped working. Then he asked us to do the unthinkable — to take the handkerchiefs off and uncover our nose! His tone was particularly terse and he accused us of being ‘disrespectful’ to the dead person and declared us ‘unfit to be doctors’. He pointed out that neither himself, nor the rest of the staff attending to the autopsy had made any attempt to cover their noses or to shield themselves from the stench — it was a part of their job. Trying to cover the nose, in his opinion, amounted to showing disrespect to the dead person. Both of us stayed put through the autopsy, with our noses uncovered.
Over the years since then, I have experienced the most repulsive of odours as part of my profession on numerous instances, including the other day in our emergency department. I am reminded of that day in the autopsy room as a student every time and I stop myself from reacting in any way. I do my best to keep a straight face, and never show unpleasantness to the patient or his caregiver. I never cover my nose in an attempt to keep the smell out. I do register the stench, but I do not react. Doing so, I had been taught, would be an insult and a source of embarrassment to the patient and his or her caregivers….
( sparameswaran@outlook.com)
